Understanding chronic pain

Most people think of pain as resulting from physical injury or disease, but psychological factors play a huge role in pain perception. Our expectations, mood and perspective on pain powerfully influence how much something actually hurts and the decisions we make every day. The perception of pain involves far more than mere sensation; pain can be viewed as merely a ‘’signal’’ that something is wrong somewhere in the body, until it reaches the emotional part of the brain, where this signal becomes what we feel or interpret as pain.{{more}}

The perception of even acute pain is highly dependent on the context in which it occurs. Therefore, the pain of menstrual cramps, experienced by women on a regular monthly basis, would be far different to the pain resulting from a vehicular accident or as a result of a terminal illness. Each experience of pain carries its own emotional weight and the ability to cope varies remarkably, depending on the story associated with the cause of the pain.

How should we deal with pain?

Attention:

Focusing one’s attention on pain makes the pain worse. Some persons are over vigilant about sensations experienced in their bodies; it has been found that by attending to these sensations, they amplify them to the point of feeling painful.

Conversely, distracting patients is highly effective in reducing their pain. Burn patients undergoing treatments or physical therapy experience excruciating pain, even after they have been given very strong medications. It has been shown that these patients report only a fraction of this pain if they are distracted significantly during the procedure.

Anxiety:

Anxiety, fear, and a sense of loss of control contribute to patient suffering. Treating anxiety and providing psychological support has been shown to improve pain. Improving patients’ sense of control and allowing them to participate in their care is also helpful. It is important that doctors try to create an environment that is nonthreatening for their patients. For procedures, prepare needles and other equipment out of sight of the patient. In addition to assuring that procedures are performed in the least painful way possible, use non-threatening words when communicating with patients, such as ‘’mild discomfort’’ instead of ‘’pain.’’ It is also helpful and useful to distract patients with conversations about subjects that interest them, such as their hobbies or family, to alleviate some of their anxiety.

Memory:

Patients who have low levels of pain remember it as being worse than they originally reported, which tends to worsen with time. Almost all patients report relief with treatment, even when true measured changes in pain scale are not significant, and sometimes when measured pain is worse. Many women who would have experienced childbirth would be reminiscent of the excruciating pain of labour, but then remarkably after delivery that pain somehow miraculously disappears. Psychologists believe that it’s the euphoric joy of seeing the baby for the first time, which causes the physical pain to be replaced by such overwhelming emotions.

Learned Pain:

Pain can be a learned response, rather than a purely physical problem. Just as cancer patients can develop nausea as a learned response to treatment and experience it even before chemotherapy is administered, patients can learn to have pain even in the absence of a physical stimulus. In some cases, pain can be entirely ‘’in the mind,’’ as in the case of a boy who slipped while running on gravel and ripped his pants at the knees, and began screaming as in great agony. Then, on closer examination of the ‘wound,’ he learned that there was no bruise and he was actually uninjured…his pain is then resolved.

Beliefs and Coping:

Other psychosocial issues, such as what patients believe about their pain, their coping skills, their tendency to ‘’make a situation worse than it really is’’, self-efficacy (individual’s belief in his or her, own abilities), and their involvement in the ‘’sick role’’(The sick role is a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it), all have an impact on how much pain a patient feels, and how it affects him/her.

To successfully get patients with back pain to return to work, the most important factor identified has been a reduction in subjective feelings of disability. Doctors should focus on their improved function and long-term management. Patients should be led to understand that they themselves have an important role in distracting themselves, and that they can minimize the interference that pain has in their lives.

“We can’t avoid pain, but we can choose to overcome it.”

-Unknown

Dr Miller is Health Psychologist at the Milton Cato Memorial Hospital.